Issue 2368, Oct. 2, 2017

The California Medical Association (CMA) has published a new guide to help physicians challenge “interim payments” under the new AB 72 out-of-network billing and payment law. The guide is free and available exclusively to members in CMA’s AB 72 resource center at www.cmanet.org/ab-72. Read More

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On July 1, 2017, the new law (AB 72) took effect changing the billing practices of non-participating physicians providing covered, non-emergent care at in-network facilities including hospitals, ambulatory surgery centers and laboratories.

The law requires plans and insurers to reimburse physicians at the greater of either the payor’s “average contracted rate” or 125 percent of the Medicare fee-for-service rate for the same or similar services in the general geographic region in which the services were rendered, unless otherwise agreed to by the noncontracting provider and the payor. However, it also includes mechanisms for physicians to challenge the interim payment if they believe it to be insufficient.

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2. Are you ready for final MACRA 90-day reporting period for 2017?

Physicians who hope to earn a small bonus for the 2017 Medicare reporting year must start their 90-day performance period no later than Monday, October 2, 2017. While the actual reporting deadline is March 31, 2018, physicians need to identify and understand the measures that are relevant to their practice in order to successfully report on claims for the final 90 days of 2017.

Physicians that are reporting via claims will need to begin indicating the quality data code for the quality measure on the claim form beginning with October 2 dates of service as they submit these claims to Medicare.

Beginning with the 2017 reporting year, eligible physicians who do not participate in the Medicare Quality Payment Program (QPP) will see a negative 4 percent payment adjustment in 2019. QPP is the new physician payment system created by the Medicare Access and CHIP Reauthorization Act (MACRA) and administered by the Centers for Medicare and Medicaid Services (CMS).

During the 2017 transition year, CMS will allow physicians to select one of three “pick your pace” participation options. Participating at any level in 2017 will ensure that you will not be hit with the 4 percent pay cut in 2019. The participation levels include:

One patient, one measure: The most lenient participation option, this option allows physicians to avoid a penalty by "testing" the program to ensure that their systems are working and that they are prepared for broader implementation in 2018 and beyond. Physicians only need to report on one measure for one patient to avoid a negative penalty in 2019.

90 Days: Physicians can choose to report for 90 days and possibly earn a small bonus payment. If you plan to select this 90-day reporting option, your performance period must begin no later than October 2, 2017.

Full Year: Physicians can also choose, if they are ready, to report a full year of data in 2017 and be eligible to receive a modest bonus, depending on their performance.

CMA MACRA Resource Center

To help physicians understand the payment reforms and prepare for the transition, CMA has published a MACRA resource page at www.cmanet.org/macra. There, you will find an overview of MACRA and a comprehensive list of tools, resources and information from CMA, the American Medical Association and CMS.

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Medication-assisted treatment (MAT) for opioid addiction is an important tool that has the potential to help millions of Americans with an opioid use disorder. In fact, patients receiving MAT cut their risk of death from all causes in half, according to the Substance Abuse and Mental Health Services Administration. However, health care providers and patients face significant challenges when determining how best to treat opioid use disorder, especially when the MAT drugs contain methadone or buprenorphine – which are also opioids.

The U.S. Food and Drug Administration (FDA) recently issued a statement saying that the opioid addiction medications buprenorphine and methadone should not be withheld from patients taking benzodiazepines or other drugs that depress the central nervous system (CNS). However, the agency is requiring changes to MAT drug labels to help decrease the risks of combining these drugs.

The new labeling recommends that health care providers develop a treatment plan that closely monitors any concomitant use of these drugs, and carefully taper the use of benzodiazepines, while considering other treatment options to address mental health conditions that the benzodiazepines might have been initially prescribed to address.

Educating patients about the serious risks of combined use, including overdose and death, that can occur with CNS depressants even when used as prescribed, as well as when used illicitly.

Developing strategies to manage the use of prescribed or illicit benzodiazepines or other CNS depressants when starting MAT.

Tapering the benzodiazepine or CNS depressant to discontinuation if possible.

Verifying the diagnosis if a patient is receiving prescribed benzodiazepines or other CNS depressants for anxiety or insomnia, and considering other treatment options for these conditions.

Recognizing that patients may require MAT medications indefinitely and that their use should continue as long as patients are benefiting and their use contributes to the intended treatment goals.

Coordinating care to ensure other prescribers are aware of the patient’s buprenorphine or methadone treatment.

Monitoring for illicit drug use, including urine or blood screening.

Patients taking MAT drugs should continue to take these medicines as prescribed, and should not stop taking other prescribed medicines without first talking to their health care professional.

Physicians are encouraged to report adverse events or side effects related to the use of these products to the FDA's MedWatch Safety Information and Adverse Event Reporting Program, available online at www.fda.gov/MedWatch/report. You can also call (800) 332-1088 to request a paper reporting form.

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4. CMA, AMA and organized medicine were united in opposing Graham-Cassidy

Last week, the latest effort to repeal the Affordable Care Act (ACA) collapsed, after three Republican Senators announced their opposition—Susan Collins (R-ME), Rand Paul (R-KY) and John McCain R-AZ). Further action is unlikely this year, as Senate Republican Leader Mitch McConnell (R-KY) said the Senate would now turn its focus to overhauling the tax code. However, several Republicans vowed to continue to work into next year to repeal the ACA.

The California Medical Association (CMA), the American Medical Association (AMA) and all of organized medicine were united in opposing this harmful bill, which would have repealed the ACA’s insurance mandate, underfunded health insurance subsidies and made drastic cuts to the Medicaid program.

The Graham-Cassidy block grant proposal would have been disproportionately harmful to states like California, which embraced Medicaid expansion and increased coverage under the ACA. Even states that initially came out ahead under the block grant framework would have experienced devastating funding cuts over time from the bill’s Medicaid funding caps on children, the elderly and the disabled.

Millions of Californians would have lost their coverage, and many others would have been seriously underinsured.

Patients without coverage seek more expensive care in overcrowded emergency rooms, passing costs onto states, counties, health care providers and taxpayers. These patients also put off treatment, ending up with more serious conditions that could have been prevented. These problems would be exacerbated by the reduction of subsidies currently provided to poor and middle class families. The Graham-Cassidy bill would also have allowed states to do away with pre-existing condition protections and other essential health benefits that keep Americans healthy.

“Congress should engage with physicians and other medical experts on the front lines caring for patients to develop legislation that improves patient access to physicians, protects coverage for our most vulnerable populations and addresses affordability,” said CMA President Ruth Haskins, M.D.

In the meantime, bipartisan negotiations have resumed in the Senate between Health Committee Chairman Alexander (R-TN) and lead Democrat Patty Murray (D-WA) to adopt reforms to stabilize the individual market, such as funding cost-sharing subsidies and reinsurance. CMA and AMA support this effort.

It has been a long and difficult year for physicians who want to make constructive improvements to the health care system. While the ACA has its flaws, none of the House and Senate proposals thus far have met CMA’s principles for health care reform. CMA and the physicians of California will keep fighting for reforms that increase patient access to health care and maintain coverage for the millions of Californians insured through Medi-Cal and Covered California.

5. On-Demand Webinar: How to challenge AB 72 interim payment

The California Medical Association (CMA) recently hosted a free members-only webinar on the different options for challenging AB 72 interim payments. The webinar is now available for on-demand viewing in the CMA resource library.

Under AB 72, which took effect July 1, 2017, plans and insurers are required to make “interim payments” to non-contracted physicians for covered, non-emergent services performed at in-network health facilities. The interim payment is the greater of either the plan/insurer’s average contracted rate or 125 percent of the Medicare rate for the same or similar services in the general geographic region in which services were rendered. However, the new law does include mechanisms for physicians to challenge the interim payment.

CMA’s on-demand webinar includes an overview of the dispute options, details on how the AB 72 “independent dispute resolution process” will work and CMA resources available to assist physician members.

For more information, visit www.cmanet.org/ab-72 or call CMA’s Reimbursement Helpline at (888) 401-5911.

6. CMA urges Gov. Brown to sign responsible beverage service bill

Educating beverage servers in bars and restaurants is a key part of reducing drunk-driving fatalities. The California Legislature has passed a bill sponsored by the California Medical Association (CMA) that would require California bartenders, servers and managers to receive responsible beverage service training based on a curriculum developed by the Department of Alcoholic Beverage Control. The bill—AB 1221 (Gonzalez Fletcher)—now heads to Governor Brown for his signature.

The bill is the result of a tragic drunk-driving accident that killed two UC San Diego medical students in 2015. In the wake of the accident, classmates of the victims worked with Assemblywoman Gonzalez Fletcher and CMA to develop legislation that would better equip servers and bartenders to identify signs of overconsumption and intervene before tragedy strikes.

“Responsible beverage service training can't bring back our brilliant, compassionate classmates, but it can prevent other communities from having to mourn the senseless loss of loved ones to drunk drivers,” said Daniel Spinosa, one of the victims’ classmates at the UC San Diego School of Medicine. “This bill will empower bartenders and servers to save lives. We wish it had been law years ago.”

Responsible beverage service training provides bartenders and servers with tools to effectively identify when a patron has had too much to drink, and how to safely intervene if necessary. Eighteen other states and the District of Columbia already require such training. Three years after Oregon mandated responsible beverage service training, fatal single-vehicle nighttime crashes decreased by an estimated 23 percent.

AB 1221 is supported by health and public safety organizations including Alcohol Justice, California Academy of Preventive Medicine, California Chapters of the American College of Physicians, California Restaurant Association and Mothers Against Drunk Driving.

7. State suspends clinical lab license fees for two years

Governor Brown signed a bill (AB 658) on Sept. 28 that suspends the state's clinical laboratory license renewal fees for two years, 2018 and 2019.

The bill is a result of an audit that found that the California Department of Public Health (CDPH) had collected millions more in laboratory fees than it had spent operating the Laboratory Field Services (LFS) branch. The fund’s current reserves exceed $22 million. Under existing state law, however, CDPH could not suspend or refund these fees.

This bill only suspends renewal fees and will not apply to other fees like multiple site, personnel licensure, new lab or delinquency fees. Fees will be reinstated in 2020, but going forward CDPH will only be permitted to collect enough fees to operate its LFS branch, as spelled out in the current law.

Labs in California—including physician operated labs—should see significant savings over the next few years as licensing fees paid to the state are lowered after the freeze.

Did you know?

Did you know that COLA Laboratory Accreditation is a California Medical Association (CMA) member benefit?

COLA a physician-directed organization whose purpose is to promote excellence in laboratory medicine and patient care through a program of voluntary education, consultation and accreditation. This member benefit provides a 20 percent savings on COLA’s Laboratory Accreditation Program.

COLA is approved by LFS under state law as well as the federal CLIA program. By enrolling, your one COLA survey every two years will meet both state and federal regulations.

CMA members also receive free online support and a complimentary basic quality lab course and may be eligible for a discount on AAFP and ACP proficiency testing programs.

Click here to learn more about COLA and to access the CMA member discount code.

There’s still time to register for the Network of Ethnic Physician Organizations (NEPO) Building Healthy Communities Summit, taking place immediately before the California Medical Association (CMA) House of Delegates on October 19-20, at the Disneyland Hotel in Anaheim. This year’s conference theme – “Striving for Health Equity in the Era of Change" – will focus on emerging health policy issues and solutions as we strive to achieve health equity and reduce health disparities.

For just $299, participants can earn up to 10.5 AMA PRA Category 1 Credits™. Medical students receive a discounted rate of $75.

The summit agenda will include a thought-provoking array of plenary sessions and workshops. Attendees will hear from nationally acclaimed thought leaders, learn about emerging health care policy issues and share best practices on how to reduce health disparities.

Featured speakers include:

Senator Ricardo Lara (District 33), author of the Health For All Act

Robert K. Ross, MD, President and CEO of The California Endowment, dedicated to building healthy communities

This annual symposium has drawn an increasing crowd of motivated physicians, interested in advancing their expertise in health policy as an adjunct to their practice of medicine. The NEPO Summit will provide you with opportunities to network with policymakers, health care advocates and thought leaders while enjoying breakout sessions on topics as diverse as the impact of immigration laws on health care, physician mental health, and addressing maternal morbidity and mortality.

9. Last chance: Limited tickets still available for annual Gala!

The California Medical Association (CMA) and the CMA Foundation invite you to the 21st annual President’s Reception and Awards Gala on the evening of Saturday, October 21, 2017, at the Disneyland Hotel in Anaheim. The black tie event will immediately follow CMA’s annual House of Delegates session that day.

A limited number of individual tickets are available for purchase. This special event is expected to sell out, so secure your seats today! There will be no onsite or week-of ticket sales.

Each year, CMA and the CMA Foundation honor the extraordinary leadership of individuals and organizations making a difference in the health of Californians. The incoming CMA president and recipients of the Gary S. Nye, M.D., Award for Physician Health and Well-Being; the Robert D. Sparks, M.D., Leadership Award; and the Adarsh S. Mahal, M.D., Access to Health Care and Disparities Award will be recognized at this prestigious event, which includes a cocktail reception, dinner, inspiring program, live auction and exciting entertainment.

10. CPPPH offers regional workshops on physician well-being

California Public Protection and Physician Health. Inc. (CPPPH) is hosting two fall workshops for hospital medical staffs and groups interested in physician health and well-being. The workshops will be held in Oakland on Saturday, October 7, and in Los Angeles on Saturday, November 4.

The workshop, "Effective Functioning of Wellbeing Committees," is intended for hospital medical staff, medical groups, specialty societies, and others involved or interested in improving the health and well-being of physicians. Workshop topics include:

How to handle the first meeting with a physician when it is about disruptive behavior or aging

What records the committee should keep

What the committee should be reporting to the medical executive committee and what medical staff bylaws say about it

Physicians attending can receive 7 AMA PRA Category 1 Credits™.

To register for the Oakland workshop, click here, or to register for the Los Angeles workshop, click here. For more information, email CPPPH at info@cppph.org or call (800) 381-2383.

CPPPH was established in 2009 as an independent nonprofit corporation dedicated to developing a statewide physician health program to respond to the needs articulated by physician health committees. CPPPH is funded by the California Medical Association and its component societies, the California Hospital Association, California's specialty societies, and medical liability insurance carriers and individual donors.

11. Health care providers learn tactics to improve community health

In partnership with the California Department of Public Health, the University of California, San Francisco’s Champion Provider Fellowship hosted over 60 physicians and dentists in the Central Valley for a one-day program to empower, train and support them to harness their passion to improve the health of their communities beyond the clinic setting.

The Champion Provider Fellowship provides training and education on a wide variety of health care subjects, including health promotion, food security, school wellness, safe routes to school and structured physical activity. This particular “Central Valley Mini College” focused upon the implementation of policy, systems and environmental change strategies related to obesity and diabetes prevention.

At the day-long event, the California Medical Association (CMA) led a panel titled “Policy 101: Tools to be an Effective Advocate,” which featured CMA staff and CMA Trustee Shannon Udovic-Constant, M.D., a pediatrician from San Francisco. Dr. Udovic-Constant relayed her personal experience as a physician engaging in local efforts to pass the sugar-sweetened beverage tax in San Francisco, which was approved by ballot in 2016.

“After noticing that approximately 30 percent of kids in my practice met the criteria for overweight, I asked myself how can I have an impact on the bigger picture, that is, outside the confines of the four walls of my office? And the answer was engaging in advocacy at the community level,” Dr. Udovic-Constant said.

The Champion Provider Fellowship training also included a number of skill-building workshops, with a focus on working with diverse communities throughout California. The training featured the Policy, System, Environmental Change (PSE) Playbook, which describes the problem associated with particular health-related topic areas, offers a menu of PSE solutions, and highlights two case studies, one of which focuses on implementing PSE change in a rural area.

Additionally, PrivaPlan provides security risk analyses and privacy reviews to assist CMA members in meaningful use attestation and compliance in general. PrivaPlan can also assist CMA members in completion of HIPAA policies and procedures as well as provide HIPAA breach notification investigation and follow-up services. For more information, go to www.privaplan.com.